Provider Demographics
NPI:1609980887
Name:MISSION CENTER HEALTHCARE A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:MISSION CENTER HEALTHCARE A MEDICAL CORPORATION
Other - Org Name:MISSION CENTER HEALTHCARE
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:831-757-4444
Mailing Address - Street 1:4 ROSSI CIRCLE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93907-2358
Mailing Address - Country:US
Mailing Address - Phone:831-678-8899
Mailing Address - Fax:831-678-4545
Practice Address - Street 1:2524 H DELA ROSA SR ST
Practice Address - Street 2:
Practice Address - City:SOLEDAD
Practice Address - State:CA
Practice Address - Zip Code:93960-3383
Practice Address - Country:US
Practice Address - Phone:831-678-8899
Practice Address - Fax:831-678-4545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ01510ZMedicare UPIN